Recovery of Renal Function in Black South African Patients with Malignant Hypertension: Superiority of Continuous Ambulatory Peritoneal Dialysis over Hemodialysis

Abstract

Objective To describe recovery of renal function (RC) in Black South African patients with primary malignant hypertension (MHT) and end-stage renal failure, according to the type of dialysis provided. Design A retrospective analysis of the records of 31 patients with MHT. Setting A university-based, large tertiary-care hospital and its community-based satellite continuous ambulatory peritoneal dialysis (CAPD) clinics. Patients Only patients with renal failure caused by MHT and who were on dialysis between January 1997 and June 2000. There were 11 patients on peritoneal dialysis (PD) that regained renal function; 11 patients on hemodialysis (HD), none of whom recovered renal function; and 9 patients on PD who did not recover renal function during the same time period. Outcome Measures The groups were investigated for variables that might predict RC. Results Peritoneal dialysis compared with HD was highly significant as an indicator of RC ( p < 0.0001), with 60% of patients on PD regaining renal function, versus 0% on HD. Median time to recovery was 300 (150 – 365) days. There was no significant difference in decline of mean arterial pressure (MAP) between the groups; MAP declined significantly in all groups ( p = 0.000 02). All groups received similar drug therapy. In the RC group, initial MAP, kidney size, and urine output tended to be higher and creatinine lower ( p = not significant). Dialysis adequacy was similar in the different groups. Conclusions This retrospective study suggests there may be benefit from PD as the primary form of dialysis when patients have MHT as a cause of their renal failure. Possible predictors of RC include blood pressure control, initial MAP, initial serum creatinine, initial urine output, and kidney size. Time should be allowed for RC before transplantation is undertaken. Prospective studies are needed to confirm the benefit of CAPD in patients with MHT.

Recovery of renal function after 90 d on dialysis: implications for transplantation in patients with potentially reversible causes of renal failure

“…Katz et al. (7) reported that 11/31 (36%) Black South Africans with malignant hypertension recovered sufficient renal function to discontinue dialysis after 150–365 d. A further four patients with malignant hypertension and ARF were able to stop dialysis after three months in the series reported by Yaqoob et al. (8).…”

Benefits of preserving residual renal function in peritoneal dialysis

“…Another striking finding is the fact that PD might delay the progression of advanced renal failure, preserving or improving RRF. [68][69][70][71][72][73] Actually, recovery of renal function sufficient to come off dialysis has been described in several reports of patients with interstitial nephritis 68 and malignant hypertension. 69 In an experimental model, PD retarded the progression of glomerular sclerosis in rats.…”

Tailoring dialysis and resuming low‐protein diets may favor chronic dialysis discontinuation: Report on three cases

“…The three case reports, regarding patients who were all treated at a small dialysis Unit where a "tailor-made," highly personalized dialysis regimen is pursued, may offer a few ideas for discussion, in the context of the recent medical literature, that suggest that RFR, allowing discontinuation of dialysis, may occur more frequently than is generally believed. [13][14][15][16][17][18][19][20] While there is undoubtedly a quota of serendipity in the observation of a high prevalence of RFR in our series, linked to the small number of treated patients, this experience may suggest that small settings, which allow for a policy of highly personalized treatment, may be particularly suitable for enhancing kidney function recovery. Indeed, in our opinion, the individualized follow-up policy modulated the clinical decisions mainly on the basis of dialysis tolerance: we were quite reluctant to discontinue hemodialysis in our first patient, with good dialysis tolerance; conversely, in the other two patients, dialysis was withdrawn relatively early (i.e., when GFR was still below 10 mL/min) on account of poor tolerance to the dialysis sessions (Table 1).…”

“…[14][15][16][17] In other large series published since 2000, the incidence of RFR ranges from 2% to over 30%, the highest rates being recorded in severe hypertension and cholesterol emboli syndrome. [18][19][20] The definition of RFR is quite elusive, and the duration of dialysis after which kidney failure is considered as chronic ranges from 1 to 3 months. [14][15][16][17][18][19][20] Almost surprisingly, one of the clearest definitions of "chronic" dialysis stems from the studies on acute kidney injury: the RIFLE criteria define end-stage renal disease as the need for renal replacement therapy for more than 3 months.…”

“…[18][19][20] The definition of RFR is quite elusive, and the duration of dialysis after which kidney failure is considered as chronic ranges from 1 to 3 months. [14][15][16][17][18][19][20] Almost surprisingly, one of the clearest definitions of "chronic" dialysis stems from the studies on acute kidney injury: the RIFLE criteria define end-stage renal disease as the need for renal replacement therapy for more than 3 months. 21 With this in mind, we will report on three patients with severe multiple comorbidities who recovered from a dialysis-dependent state after more than 3 months of hemodialysis.…”